Pearls for clinic flow in the age of COVID-19

Elizabeth Yeu, MD, offers five tips for adjusting the practice during the coronavirus pandemic.

This article was reviewed by Elizabeth Yeu, MD

Physicians have had to get creative quickly to cope with COVID-19 in order to maintain the health and safety of their medical staffs and patients. This sometimes has resulted in daily changes done on the fly in practices around the country.

Elizabeth Yeu, MD, shared her pearls for ensuring a safe environment before, during, and after patients arrive in her practice.

Preparing patients before their scheduled visit
Communication is everything, whether done by phone, email, or a letter before the scheduled appointment.

“Patients are nervous,” Dr. Yeu said, recounting an internal survey of 5,500 patients that found that from 25% to 50% of patients, depending on location, are not ready for an in-face office visit.

In addition, while all of the elective surgeries were put on hold because of the virus, as of May 1, two-thirds of patients want to delay those surgeries further.

So when they do come back to the practice, Dr. Yeu emphasized that things will (and must) look different. The pre-appointment communication can describe the changes made to the office setting and what they can expect. She also suggested using a patient video to help with this.

Patients use mobile phones in and out of their home and can use a computer in the office to register their arrivals.

The time that physicians and patients meet face-to-face can be reduced by changing the examination workflow. Dr. Yeu advised splitting the longer patient appointments between diagnostics and in-person evaluation with the doctor.

For example, the cataract examinations may go like this: The first appointment would be a no-touch visit that includes the preoperative diagnostics, cataract counselor, and patient education; and the second appointment would be the in-person evaluation with the physician.

For both patient education and the physician evaluation, she suggested that a future alternative might be diagnostics plus obtaining digital slit-lamp examination and/or pan-fundus photographs and a telehealth appointment with the doctor.

The frequency of follow-up appointments can be decreased by alternating follow-up visits between tele-health and in-person appointments. Drive-through evaluations of intraocular pressure and dry eye hold potential.

Regarding postoperative appointments for cataract patients who underwent a routine procedure and feel well afterward, only a virtual postoperative day 1 appointment is needed.

If moving forward with a virtual postoperative day 1 appointment, to pre-empt any IOP spikes, Dr. Yeu also advised including a Diamox (acetazolamide) 250-mg dose in the recovery room and enough brimonidine 0.2% to last twice daily for one week to the operative eye postoperatively.